7:01 AM ⏰ Continued

Taking Our First Step Out of Bed

[Continued from here]

Like an aching lower back, it’s just a matter of time until we experience foot pain.

On any given day the prevalence of pain, stiffness, and soreness among the billions of feet walking upon Earth is up to 1 in 3. And with the world population standing at 8 billion people, that means there are billions of unhappy feet swinging out of bed each morning. Foot pain is a cause of disability, impaired balance, increased risk of falls, loss of independence, and reduced quality of life. That jolting first step out of bed is also the inspiration for many inspired and articulate cursing tirades. When there is a stray Lego on the floor, with diamond-hard edges traumatizing our deep nociceptors, then blind fury is completely justified… but more often than not, a sharp tearing pain through the bottom of the foot might be just a product of our own haste.

The first step out of bed might be one small step for man, but it can be one giant leap for mankind, if we do it more carefully.

Stretch the plantar fascia.

As anyone with plantar fasciitis or chronic foot pain will confirm, that first step can be brutally painful, and often does the most damage of any step in the day. The arch of the foot is like a bow, and the plantar fascia is like a bowstring. All night the bowstring tightens, and a sudden load of 200 pounds can create some serious micro-tearing. Instead of suddenly loading the foot, we can lengthen and prepare it. Flex the feet backwards and hold this position for a count of 10. Relax. Circle the feet around at the ankle, or write a name in capital letters in the air with the big toes. Our bowstrings are awake now, too.

Sit on the edge of the bed for a few.

We’ve swung upwards by 90 degrees and are now sitting on the edge of the bed. The autonomic nervous system is sensing a significant change in vascular pressures distributed from head to toe, and is busy tightening some vessels and relaxing others. It is making sure the brain and muscles have enough oxygen, glucose, and other fuel. Pausing here for a few moments will help prevent falls and lightheadedness, and allow the heart rate, blood pressure, and somatosensory systems to more fully synchronize. The sparrows are still chirping, and it sounds like beautiful music. Except that it doesn’t, and the sparrows are still just another one of life’s unsolvable problems.

Load the feet and arches slowly.

If we are not yet 80 years old, 7:03 AM is the time to act like it anyway. If there are hardwood floors, slip the feet into slippers before launching. I love Glerups. Slowly load the arches of the feet with first 20 pounds, then 50, then 75, then 100, and so on. Get out of bed in a kind of slow motion, further stretching and lengthening the tendons, fascia, and ligaments of the feet, ankles, Achilles, and calves. Doing this each morning is the most effective technique I have personally found for helping, and then preventing, chronic foot pain.

Proceed to the toilet, and then sit back down.

Urination in the morning is an imperative that probably motivates us to rise from our slumber more than the day’s laborious to-do list. The hypothalamus has been secreting antidiuretic hormone in high levels all night in an effort to conserve water in the kidneys. This allows us to stumble through the desert of sleep until we find that ephemeral pool in a morning glass of water. Having just achieved bipedal status, we must now find the toilet, and consider sitting down all over again. Women universally sit down to urinate, but what about men?

By default most boys learn to urinate in a toilet the same way males have urinated on the Earth for millenia. But there are several good reasons to challenge this behavior. In fact, polling in a few other countries reveals that men are increasingly sitting down to urinate despite the perhaps less masculine appearance. For example, in Germany the act has an actual name - taking a sitzpinkler. And in the highly evolved society of Japan, recent polling from 2020 found that up to 70% of men sit. This is up from 50% just five years ago.

The sequence of neuromuscular events that contracts the bladder and relaxes the urethral sphincter is in part mediated by spinal reflexes and the autonomic nervous system through vagus nerve fibers. This natural act can have cross signaling with the heart and vascular networks, causing an associated drop in heart rate and blood pressure. If exaggerated this can lead to lightheadedness and even fainting. Up to 10% of all syncopal episodes occur during urination. Passing out can obviously cause major injuries like broken bones, head trauma, internal and external bleeding, and lacerations to name just a few I have seen.

Sitting to urinate will decrease the need for compensatory cardiovascular responses, and helps prevent light headed spells and consequent injuries. It eliminates splashing on the seat and floor, which we can all agree is gross. And even when men hit the mark inside the toilet bowl, there is still a lot of sploshing going on. The urine stream itself produces microscopic droplets that can travel around the bathroom and land on surfaces like toothbrushes. Fluid dynamics produce rising droplets at the toilet water level, too. Splashing causes bacteria like E. coli and other nasty fecal organisms floating around to become suspended in the air. And finally, for middle aged and older men, urinary flow parameters are significantly improved when sitting down. If you like technical details, one study showed: “Qmax is increased, PVR is lowered and time spent urinating is shorter than in the standing position.” And if you like masculine celebrity cover for this otherwise feminine peeing position - rest assured that soccer great Lionel Messi admitted that he too sits down to urinate.

Legos used instructively, and not left on the floor next to the bed.

To be continued again :)